EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/387844
EW NEWS & OPINION 28 October 2014 malpractice insurance. In the Senate you can't practice at all and I can't bring in any income to offset my malpractice insurance, which is not a great business model. Dr. Chang: What do you miss most about ophthalmology now that you're no longer practicing? Sen. Paul: The difference between politics and medicine is this: In politics, sometimes people know of a solution, but we rarely ever execute the correct solution. Groucho Marx said, "The art of politics is looking everywhere for problems, finding them, misdiagnosing them, and then applying the wrong solution." But in medicine you get feedback immediately. Most of it in ophthal- mology is positive feedback, and I think that's one of the reasons I really like ophthalmology. There are very few sad patients, and 99% of them are going to see better. Dr. Chang: Looking at your career as a senator, are there situations where being an ophthalmologist has been helpful to you? Sen. Paul: I'm very aware of what the reduced payments are doing to physicians' practices and their abil- ity to pay employees and continue to stay in practice. The formula for how we pay doctors out of Medicare means reimbursement has been going down every year. Right when I started practicing, reimbursement They do a great job because they've done dozens of missions, probably nearly a hundred missions around the country and around the world. We also enlisted help from locals— for example, the Lions Club. There's a lot of work that goes into finding out who the patients are who need the treatment. Dr. Chang: How did you decide in the midst of being a busy private practitioner to run for office? Sen. Paul: My wife still thinks I was a little crazy to do this. I had just opened up a practice. I bought my own building because I always wanted a small practice where I was in charge of everything, and I had done that for about a year and a half. Then the Senator from Kentucky was waffling on whether he was going to run or not—and I thought, "Maybe I'll run." After I said this to a reporter, it sort of steamrolled and there was no look- ing back. It was the first time I had ever run for office and eve yone, including myself, thought it was un- likely that I would win. I thought all along as I ran for office that I'd still be allowed to practice medicine part time, but I discovered that the rules are different between the House of Representatives and the Senate. In the House of Representatives, the doctors still can practice—there's about 15 or 20 doctors in the House. Some of them practice part time, and they can still cover their to have trouble. We had a patient last week in Louisville who had insurance but had a $6,000 deduct- ible. A big question I have about the healthcare bill is that you can give people free insurance, but if it's free insurance with a $6,000 deductible, where are they going to get the money? So I think we're still going to have an access problem. I think the other problem we're going to have is that as we pay hospitals less, hospitals are going to have to let people go. That's what I really fear is that some of the good paying jobs in our country, particularly in rural communities, are people who work for the hospitals. Dr. Chang: The ASCRS Foundation is involved with a number of interna- tional partners and NGOs working on cataract blindness. Have you done international trips before and what's your impression of the Moran team? We're in a pretty remote, rural area of Guatemala right now, and it's pretty amazing what they've put together. Sen. Paul: This is my first inte - national trip. Dr. Crandall and his team have done a great job—we have sophisticated microscopes from North America, we've got 2 phaco machines, and it's running like clockwork. It really takes a lot of effort. I contemplated doing this on my own and said, "I'll get together a team," but then thought, "No, I don't want to reinvent the wheel." Not only did we collect glasses, but we did some pro bono surgery on folks who came up here, mostly from Latin America and some from South America but also some people from the community as well. We have this debate about healthcare— how much should the government be involved and how much should private enterprise be involved? We lose track of the fact that all of us [physicians] feel an obligation to help people whether they have any money or not. I think it gets lost in all the debate about healthcare and Obamacare—that ever since I was a kid, doctors have been trying to help and have always felt an obligation to help the poor members of their community. Dr. Chang: This year, the ASCRS Foundation is launching an initia- tive to facilitate and support ASCRS members and their ASCs who want to operate on cataract patients who cannot afford care in the United States. Our eventual goal is to eradi- cate cataract blindness in the U.S. As you said, a lot of ophthalmologists have already been doing this all along, but this is a way to network everyone's efforts. Sen. Paul: One of the patients we did recently was a veteran who could go to the VA but it would have taken 4 hours to get there—so even when you have complete access and complete coverage for everyone, there are still people who are going Sitting down continued from page 27 Left to right: Jeff Pettey, MD, David Chang, MD, Susan MacDonald, MD, Roger Furlong, MD, and Alan Crandall, MD Susan MacDonald, MD, examines patients at the hospital in Guatemala.